保肛手术后远端切缘≤1毫米与直肠癌复发：远端切缘阳性在直肠癌手术中的作用

A Distal Resection Margin of ≤1 mm and Rectal Cancer Recurrence After Sphincter-Preserving Surgery: The Role of a Positive Distal Margin in Rectal Cancer Surgery.

作者信息

Zeng Wei-Gen, Liu Meng-Jia, Zhou Zhi-Xiang, Wang Zhen-Jun

机构信息

1 Department of General Surgery, Beijing Chao-yang Hospital, Capital Medical University, Beijing, China 2 Department of Ultrasound, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China 3 Department of Colorectal Surgery, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China.

出版信息

Dis Colon Rectum. 2017 Nov;60(11):1175-1183. doi: 10.1097/DCR.0000000000000900.

DOI:10.1097/DCR.0000000000000900

PMID:28991082

Abstract

BACKGROUND

There is little information about the prognostic value of a microscopically positive distal margin in patients who have rectal cancer.

OBJECTIVE

We aimed to investigate the influence of a distal margin of ≤1 mm on oncologic outcomes after sphincter-preserving resection for rectal cancer.

DESIGN

This is a retrospective cohort study.

SETTINGS

The study was conducted at 2 hospitals.

PATIENTS

A total of 6574 patients underwent anterior resection for rectal cancer from January 1999 to December 2014; 97 (1.5%) patients with a distal margin of ≤1 mm were included in this study. For comparative analyses, patients were matched with 194 patients with a negative distal margin (>1 mm) according to sex, age, BMI, ASA score, neoadjuvant treatment, tumor location, and stage.

MAIN OUTCOME MEASURES

The oncologic outcomes of the 2 groups were compared.

RESULTS

Perineural and lymphovascular invasion rates were significantly higher in patients with a positive distal margin (54.6% vs 28.9%; 67.0% vs 42.8%; both p < 0.001) compared with to patients with negative distal margin. Comparison between microscopically positive and negative distal margin showed worse oncologic outcomes in patients with a microscopically positive distal margin, including 5-year local recurrence rate (24.1% vs 12.0%, p = 0.005); 5-year distant recurrence rate (35.5% vs 20.2%, p = 0.011); 5-year disease-free survival (45.5% vs 69.5%, p < 0.001); and 5-year OS (69.2% vs 79.7%, p = 0.004). Among the 97 patients with a microscopically positive distal margin, the 5-year disease-free survival rate was higher in patients who received adjuvant therapy (52.0% vs 30.7%, p = 0.089).

LIMITATIONS

This is a retrospective study; bias may exist.

CONCLUSIONS

A distal margin of 1 mm is associated with worse oncologic results. Our data indicate the importance of achieving a clear distal margin in the surgical treatment of rectal cancer. Adjuvant therapy should be used in these patients to reduce recurrence. See Video Abstract at http://links.lww.com/DCR/A408.

摘要

背景

关于直肠癌患者显微镜下切缘阳性的预后价值，相关信息较少。

目的

我们旨在研究直肠癌保肛切除术后切缘≤1毫米对肿瘤学结局的影响。

设计

这是一项回顾性队列研究。

地点

该研究在两家医院进行。

患者

1999年1月至2014年12月，共有6574例患者接受了直肠癌前切除术；本研究纳入了97例（1.5%）切缘≤1毫米的患者。为进行比较分析，根据性别、年龄、体重指数、美国麻醉医师协会（ASA）评分、新辅助治疗、肿瘤位置和分期，将这些患者与194例切缘阴性（>1毫米）的患者进行匹配。

主要观察指标

比较两组的肿瘤学结局。

结果

与切缘阴性的患者相比，切缘阳性的患者神经周围和淋巴管侵犯率显著更高（分别为54.6%对28.9%；67.0%对42.8%；p均<0.001）。显微镜下切缘阳性与阴性患者的比较显示，切缘阳性的患者肿瘤学结局更差，包括5年局部复发率（24.1%对12.0%，p = 0.005）；5年远处复发率（35.5%对20.2%，p = 0.011）；5年无病生存率（45.5%对69.5%，p < 0.001）；以及5年总生存率（69.2%对79.7%，p = 0.004）。在97例显微镜下切缘阳性的患者中，接受辅助治疗的患者5年无病生存率更高（52.0%对30.7%，p = 0.089）。